Source: UNIVERSITY OF MISSISSIPPI submitted to NRP
LEVERAGING PRODUCE PRESCRIPTIONS TO INCREASE ACCESS TO FRESH PRODUCE IN THE MS DELTA: INVESTING IN HISTORICALLY MARGINALIZED COMMUNITIES
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
OTHER GRANTS
Reporting Frequency
Annual
Accession No.
1029474
Grant No.
2022-70424-38463
Cumulative Award Amt.
$500,000.00
Proposal No.
2022-07033
Multistate No.
(N/A)
Project Start Date
Sep 15, 2022
Project End Date
Sep 14, 2025
Grant Year
2022
Program Code
[PPR]- Produce Prescription
Recipient Organization
UNIVERSITY OF MISSISSIPPI
(N/A)
MISSISSIPPI,MS 38677
Performing Department
(N/A)
Non Technical Summary
This proposed food prescription program will increase access to fruits and vegetables 35 housholds in a rural, historically margianlized community. Simultaneously the program will integrategrocery retailers, local decision-makers, andthe school district into community-wide nutrition and health programming. The community is well poised to take advantage of the benefits of this program as part of a constellation of community development activities they are currently engaged in. This program, in partnership with this community willserve as a model for other rural communities facing similar challenges. Long-term (36-month) recording of biometrics, nutrition self-efficacy, and healthcare costs for enrolled participantswillcontribute to the growing, but limited evidence-base on effectiveness of food prescirption programs as a long-term healthcare strategy for nutritionally vulnerable households. Importantly this program will generate a community generated toolkit designed to lower the threshold of entry for other rural spaces, as well as tailored policy commentary to help decision-makers things about the future of foor prescription programs.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
8056099308030%
9036099308025%
6086099308015%
8036099308030%
Knowledge Area
805 - Community Institutions, Health, and Social Services; 803 - Sociological and Technological Change Affecting Individuals, Families, and Communities; 608 - Community Resource Planning and Development; 903 - Communication, Education, and Information Delivery;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3080 - Sociology;
Goals / Objectives
Goal 1. Improve household wellbeing and self-efficacy related to nutrition and chronic condition morbidityObjective 1. Provide biweekly access to fruits and vegetables for low-income/at-risk households as measured by biweekly grocery receipts.Objective2. Increase household knowledge base around nutrition/disease management through group and tailored nutrition educationGoal 2. Document long-term benefits of improved fruit and vegetable access and nutrition educationObjective 1. Maintain 85% retention rate to measure long-term benefits by building an adaptive participant driven experiencesObjective 2. Document reduced use of healthcare services and lower healthcare costsObjecitve 3. Document fruit and vegetable intake and biometric indicator changes over 36 monthsGoal 3: Improve Comunity-level capacity for administering, maintaining, and supporting health and nutrition programming (e.g. food prescription program).Objective 1. Increase/improve cross-sector communication (health / food system) based on evaluation data.Objective 2. Identify policy recommendations to support program sustainability and scalability: (1) through local ordance development; (2)changes to school wellness policies; (3) established changes in clinical care protocols at the local clinics.Objective 3.Establish scalable processes with low threshold for use/entry in other geographies based on evaluation by neighboring counties.Objective 4. Create an easy to use, community vetted toolkit for development of food prescription programs in rural spaces.
Project Methods
Efforts:Biometric and Survye data will be collected quarterly from households at their punch card renewal. The surveys used include food frequency modules of the BRFSS, NAHNES, and PANSE.Nutrition education will be delivered at three potential points for each household:1. School-level where all students are exposed or participate.2. Household level: each time the household renews their punch card.3. Individual level: for those eligible or with insurance, tailored DSME which is delivered on a schedule determined by the patient.Community Capacity Assessment1. Focus groups and workshops will be administered quarterlyEvaluation:Qualitative Data from focus groups/community meetings:Whenever possible all interviews and focus group meetings will be digitally recorded and completely transcribed using an AI based platform (TRINT). When recordings are not possible data collectors will complete comprehensive field notes following the interview guides for both the interviews and focus groups. All data will be subjected a qualitative content analysis, which is a process used to identify recurring themes within the interviews and transcripts. Quarterly reports will be developed and shared with the larger project team to allow for any adjustments to programming which might be needed based on household feedback. As an example, the recent evaluation of this program utilized qualitative data from pilot participants where themes determined a bottleneck to meaningful participation was the rigid shopping schedule. As a result the implementation team worked with participants to find a model that was flexible, but also provided opportunities to regularly check in with participants.Biometric & Survey Data (including PANSE, BRFSS, NHANES): Will be analyzed using standard statistical operations to test for significant changes from baseline.

Progress 09/15/23 to 09/14/24

Outputs
Target Audience:Our household retention rate is 86% (with 31 of the 36original households still participating). However, that translates to 54 of the original 71 participants remaining in the program (a 76% retention rate). Reasons for attrition include mortality, time constrains associated with follow-up (survey & biometric) Ninety nine percent of the patients enrolled are African American, living with either low food security status or a qualifying chronic condition. Educational programming has been made available at the local grocery store which serve the Quitman county and surrounding counties... Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Training in community nutrition for undergraduate and graduate students. Two graduate students working in community development/community based research have completed theses related to this work. Training to grocery store managers on customer preferences and establishing nutrition programming in-store. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Draft, in partnership with community the tool kit. Report out initial results in spring 2025. Begin plans to work with local non-profit to takeover management of the program based on initial qualitative evaluation data from summer 2024.

Impacts
What was accomplished under these goals? Goal 1. Improve household wellbeing and self-efficacy related to nutrition and chronic condition morbidity Objective 1. Success. One-year remaining. Objective2. Evaluating. Initial analysis to be completed January 2025 Goal 2. Document long-term benefits of improved fruit and vegetable access and nutrition education Objective 1. success. Objective 2. on-going. Evaluation of preliminary data January 2025 Objecitve 3. on-going. Evaluation of preliminiary data January 2025 Goal 3: Improve Comunity-level capacity for administering, maintaining, and supporting health and nutrition programming (e.g. food prescription program). Objective 1. Initial community conversations complete. Reviewing data to identify training/educational opportunities. Objective 2. To be completed in year 3--work with Harvard to be initiatied December 2024 Objective 3.On-going but initial technical documents drafted and publication of early results (from other funded project) completed. Currently drafting template/outline of "how to manual" Objective 4. On-going

Publications


    Progress 09/15/22 to 09/14/23

    Outputs
    Target Audience:Enrollment of patients is complete. Total sample is 71 patients, including the primary head of household, partners, and children in the home. The total number of households enrolled are 36. Ninety nine percent of the patients enrolled are African American, living with either low food security status or a qualifying chronic condition. Educational programming has been made available at the local grocery store which serve the Quitman county and surrounding counties... Changes/Problems:Major change is involvement of clinical personnel. Due to workload, the clinic and school nurse are unable to stay involved. Our clinical nutrition partner is still engaged and supporting with medical nutrition therapy as requested by patients. This limits access to medical records, but we have retooled our survey instrument to capture validated self-report data What opportunities for training and professional development has the project provided?Training on biometric data collection for students. (yes, undergraduate and graduate) Training on community development and methodological processes for nutrition student. (yes, two graduate students, also 2 undergraduate students) Training in interdisciplinary team science for nutrition, pharmacy, and community development classes (yes--though formal course work currently unavailable, training is occuring for PI and Co-PI mentees) How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Initiate community listening session and focus groups Scale up nutrition education with local after school programs Enrollment of households into tailored nutrition therapy

    Impacts
    What was accomplished under these goals? Goal 1, Obj. 1. Voucher system is now fully implemented and households are able to access, on demand fruits and vegetables. We receive grocery receipts for inventory monthly. Goal 1, Obj. 2. Nutrition education started summer of 2023 and the first round of evaluation took place in Sept so nothing to report to-date Goal 2, Obj. 1. Current retention rate is 91% Goal 2, Obj. 2. Currently documenting through self report. On track. Goal 2, Obj. 3. Currently documenting. On track. Goal 3, Obj. 1. Activities to facilitate this objective are currently being implemented. Goal 3, Obj. 2. Slated for year 3 Goal 3, Obj. 3. In process, on track Goal 3, Obj. 4. slated for year 3

    Publications